Tuberkloma

Vikipediya, ochiq ensiklopediya

Tuberkuloma sil kasalligining klinik ko'rinishi sanalib, silni qattiq bo'lakka aylantiradi va shu sababli tibbiy ko'rish tadqiqotlarida ko'plab turdagi saraton o'smalarini taqlid qilinishi mumkin. [1] [2] Ular asosan tuberkulyozning asosiy infektsiyasi yaxshi nazorat qilinmagan insonlarda paydo bo'ladi. [3] Tuberkulomalar intrakranial tarzda paydo bo'lganda, ular CNS sil kasalligining namoyon bo'lishini bildiradi. [3] Bu birlamchi kompleksning evolyutsiyasi bo'lgani sabab tuberkulyomalarda kazeum yoxudkalsifikatsiya bo'lishi mumkin.

Vaqt o'tish mobaynida tuberculosis mikobakteriyasi kaltsiy kristallarga aylanishi mumkin. Ular miya, [4] [5] ichak, [6] [7] [8] tuxumdonlar, [9] [10] ko'krak, [11] [12] [13] o'pka, [14] kabi har qanday organga ta'sir o'tkazish mumkin. [15] [16] qizilo'ngach, [17] oshqozon bezi, [18] suyaklar, [19] [20] va boshqalar. Hattoki ko'rsatmalarga asoslangan davolanish tufayli ular ko'pincha bir necha oylar balki yillargacha davom etishi mumkin. [3]

Ishlashi[tahrir | manbasini tahrirlash]

Tuberkuloma rivojlanishining aniq mexanizmi topilmagan, lekin bir nechta nazariyalar taklifi kelib tushgan. Bakteremiyaga olib keladigan dastlabki sil infektsiyasidan so'ng, granulomatoz yallig'lanish o'choqlari kazeoz tuberkulyomaga qo'shilishi mumkin. [21] O'pka tuberkulyomasi nekrozning takroriy tsikllari va o'choqlarning qayta inkapsulyatsiyasi yoxud muqobil ravishda kapsulalangan zichliklarning qisqarishi va qo'shilishi natijasida paydo bo'lishi mumkin. [22]

CNS tuberkulyomasi bilan bog'liq holatda, mikobakteriya tuberkulyozi bakterial tayoqchalar xilma-xil immunologik hujayralar orqali sitokinlarning chiqarilishini qo'zg'atgandan keyin, qon miya to'sig'iga kirib borishi mumkin, bu esa to'siq o'tkazuvchanligini o'sishiga sabab bo'ladi. [23] O'pka tuberkulyomalariga kabi, kichik jarohatlar oxir-oqibat birlashadi va nekroz va kengayishdan o'tadi. [23]

Semptomlar tuberkulyomaning turgan joyiga bog'liq. Kichik, tarqoq lezyonlar asemptomatik bo'lishi mumkin. Bolalardagi intrakranial tuberkulyomalar ko'pincha infratentorial sanalib, serebellum va miyaning asosi yaqinida sodir bo'ladi. Bu populyatsiyada meningitli yoxud menenjitsiz papillomaga [3] ravishda bosh og'rig'i, isitma, fokal nevrologik topilmalar va tutilishlar singari alomatlar kuzatilgan. [21] Miya sopi tuberkulyomasi to'rtinchi qorinchaning torayishi darajasiga yetganda, obstruktiv gidrosefali va unga bog'liq alomatlar sodir bo'lishi mumkin. [21] Araxnoidga birlashgan tuberkulyomalarning yorilishi araxnoiditga sabab bo'lishi mumkin [24], subaraknoid bo'shliq yoxud qorincha tizimi yonida yorilishi meningitga sabab bo'lishi mumkin. [23]

Diagnostika[tahrir | manbasini tahrirlash]

Tuberkuloma diagnostikasi qiyin bo'lishi sanaladi, chunki invaziv tekshiruv talab qilinish mumkin va vaqti-vaqti bilan birga paydo bo'ladigon malign o'sma paydo bo'lishadi. [22] Tuberkuloma sabab og'rigan kichik yoshdagi bolalarda TST/ IGRA musbat bo'lishiga qaramay, CXR ko'pincha normal hisoblanadi. [3]

Miya tuberkulyomasi diagnostikasi miya omurilik suyuqligining PCR yordamida sabab berishi mumkin, lekin lezyonlarni tezda tashxislash yoki davolash uchun unchalik foyda bermaydi. [23] Tuberkulomaga shubha qilingan kasallarda CSF tahlil qilinganda, ba'zan yuqori protein konsentratsiyasi va hujayralar soni kuzatiladi. [25]

Aniq diagnostikani stereotaktik, KT bo'yicha biopsiya yordamida amalga oshirish mumkin, ba'zi hollarda eksizyon talab qilinadi. Biopsiya invaziv bo'lmagan testlar tashxis aniqlanayotganda muvaffaqiyatsizlikka uchraganda, kasallar davolanish rejimiga javob bermasa, dorilarga chidamli sil kasalligi va to'g'ri kelmaydigan bemorlar tanlanadi. [23]

Tasvirlash[tahrir | manbasini tahrirlash]

Rasmda tuberkulomaning tasvirlanishi massaning tarkibi va yoshi orqali farq qilishini ko'rish mumkin. Ular kazeatsiz yoxud qattiq kazeatsiyalangan lezyonlar kabi ko'rinishi mumkin. [21] Birinchi, tuberkulyomalar kompyuter tomografiyasi orqali (KT) gipodenziya ko'rinadi va atrofda shish paydo bo'ladi. [24] [3] "Nishon belgisi" KTda tuberkulyoma uchun patognomonik bo'lib, tugunli halqani kuchaytiruvchi massa va markaziy kalsifikatsiyaga ega. [25] [21] Xarakterli halqali ko'rinish o'rta nekrotik yadroda qon ta'minoti tanqisligi bilan bog'liq bo'lib, u kontrastli kontrast orqali tasvirlangan. [23] Ba'zida kalsifikatsiya o'rniga hipodens markaziy hududi ko'rinadi. [26] Differentsial diagnosda tsisterkoz, pyogenik xo'ppoz va neoplastik lezyonlar singari potentsial intrakranial massalar ko'rib chiqishda tuberkulomani katta o'lchami (>2) orqali bilish mumkin. sm), shish yoki tartibsiz chegarasi.

  1. ↑ "Tuberculosis mimicking cancer--a reminder". The American Journal of Medicine 76 (5): 822–5. May 1984. doi:10.1016/0002-9343(84)90993-8. PMID 6720729. 
  2. ↑ "Tuberculosis and cancer: a complex and dangerous liaison". The Lancet. Oncology 12 (6): 520–2. June 2011. doi:10.1016/S1470-2045(11)70105-X. PMID 21624773. 
  3. ↑ 3,0 3,1 3,2 3,3 3,4 3,5 Clinical tuberculosis, Sixth Lloyd N. Friedman: , Boca Raton, FL, 2020. ISBN 978-1-351-24998-0. OCLC 1145905400.  Manba xatosi: Invalid <ref> tag; name ":0" defined multiple times with different content
  4. ↑ "Cerebral tuberculoma". Thorax 61 (10): 922. October 2006. doi:10.1136/thx.2005.054932. PMID 17008487. PMC 2104774. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2104774. 
  5. ↑ "Brain tuberculomas, tubercular meningitis, and post-tubercular hydrocephalus in children". Journal of Pediatric Neurosciences 6 (Suppl 1): S96–S100. October 2011. doi:10.4103/1817-1745.85725. PMID 22069437. PMC 3208909. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3208909. 
  6. ↑ "Tuberculoma of the Caecum: Hyperplastic Tuberculosis". Annals of Surgery 81 (4): 801–20. April 1925. doi:10.1097/00000658-192504000-00009. PMID 17865239. PMC 1399989. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1399989. 
  7. ↑ "Concomitant tuberculosis and carcinoma colon: coincidence or causal nexus?". Saudi Journal of Gastroenterology 16 (4): 292–4. 2010. doi:10.4103/1319-3767.70619. PMID 20871197. PMC 2995101. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2995101. 
  8. ↑ "Jejunal adenocarcinoma: an elusive diagnosis". Indian Journal of Surgical Oncology 2 (3): 197–201. September 2011. doi:10.1007/s13193-011-0101-7. PMID 22942611. PMC 3272177. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3272177. 
  9. ↑ "Peritoneal tuberculosis mimicking advanced-stage epithelial ovarian cancer". Obstetrics and Gynecology 110 (6): 1417–9. December 2007. doi:10.1097/01.AOG.0000295653.32975.4a. PMID 18055741. https://archive.org/details/sim_obstetrics-and-gynecology_2007-12_110_6/page/1417. 
  10. ↑ "Isolated ovarian tuberculosis mimicking ovarian carcinoma: case report and literature review". African Journal of Infectious Diseases 5 (1): 7–10. 2011. doi:10.4314/ajid.v5i1.66508. PMID 23878702. PMC 3497843. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3497843. 
  11. ↑ "Tuberculosis of the breast". Annals of Thoracic Medicine 3 (3): 110–4. July 2008. doi:10.4103/1817-1737.41918. PMID 19561892. PMC 2700437. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2700437. 
  12. ↑ "Isolated primary breast tuberculosis: report of three cases and review of the literature". Clinics 64 (6): 607–10. 2009. doi:10.1590/S1807-59322009000600019. PMID 19578668. PMC 2705158. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2705158. 
  13. ↑ "Mammary tuberculosis -- importance of recognition and differentiation from that of a breast malignancy: report of three cases and review of the literature". World Journal of Surgical Oncology 5: 67. June 2007. doi:10.1186/1477-7819-5-67. PMID 17577397. PMC 1910599. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1910599. 
  14. ↑ "Facts and fiction of the relationship between preexisting tuberculosis and lung cancer risk: a systematic review". International Journal of Cancer 125 (12): 2936–44. December 2009. doi:10.1002/ijc.24636. PMID 19521963. 
  15. ↑ "Facts and fiction of the relationship between preexisting tuberculosis and lung cancer risk: a systematic review". International Journal of Cancer 125 (12): 2936–44. December 2009. doi:10.1002/ijc.24636. PMID 19521963. 
  16. ↑ "The calcified lung nodule: What does it mean?". Annals of Thoracic Medicine 5 (2): 67–79. April 2010. doi:10.4103/1817-1737.62469. PMID 20582171. PMC 2883201. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2883201. 
  17. ↑ "Unusual presentation of esophageal tuberculosis mimicking malignancy". Saudi Journal of Gastroenterology 14 (2): 103–4. April 2008. doi:10.4103/1319-3767.39632. PMID 19568514. PMC 2702907. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2702907. 
  18. ↑ "Hepatobiliary and pancreatic tuberculosis: a two decade experience". BMC Surgery 7 (1): 10. June 2007. doi:10.1186/1471-2482-7-10. PMID 17588265. PMC 1925057. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1925057. 
  19. ↑ "Dangerous errors in the diagnosis and treatment of bony tuberculosis". Deutsches Ärzteblatt International 106 (36): 573–7. September 2009. doi:10.3238/arztebl.2009.0573. PMID 19890413. PMC 2770211. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2770211. 
  20. ↑ "Tuberculosis of the foot: An osteolytic variety". Indian Journal of Orthopaedics 46 (2): 206–11. March 2012. doi:10.4103/0019-5413.93683. PMID 22448060. PMC 3308663. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3308663. 
  21. ↑ 21,0 21,1 21,2 21,3 21,4 Gupta, Monica; Munakomi, Sunil (2022), „CNS Tuberculosis“, StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 36256788, qaraldi: 2022-10-31 Manba xatosi: Invalid <ref> tag; name ":2" defined multiple times with different content
  22. ↑ 22,0 22,1 Lee, H. S.; Oh, J. Y.; Lee, J. H.; Yoo, C. G.; Lee, C. T.; Kim, Y. W.; Han, S. K.; Shim, Y. S. et al. (March 2004). "Response of pulmonary tuberculomas to anti-tuberculous treatment". The European Respiratory Journal 23 (3): 452–455. doi:10.1183/09031936.04.00087304. ISSN 0903-1936. PMID 15065838.  Manba xatosi: Invalid <ref> tag; name ":4" defined multiple times with different content
  23. ↑ 23,0 23,1 23,2 23,3 23,4 23,5 Perez-Malagon, Carlos David; Barrera-Rodriguez, Raul; Lopez-Gonzalez, Miguel A.; Alva-Lopez, Luis F. (December 2021). "Diagnostic and Neurological Overview of Brain Tuberculomas: A Review of Literature". Cureus 13 (12): e20133. doi:10.7759/cureus.20133. ISSN 2168-8184. PMID 34900500. PMC 8648135. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=8648135.  Manba xatosi: Invalid <ref> tag; name ":1" defined multiple times with different content
  24. ↑ 24,0 24,1 Office practice of neurology, 2nd Martin A. Samuels: , Philadelphia: Churchill Livingstone, 2003. ISBN 978-0-7020-3588-3. OCLC 324998368.  Manba xatosi: Invalid <ref> tag; name ":3" defined multiple times with different content
  25. ↑ 25,0 25,1 The microbiology of central nervous system infections Kateryna Kon: , London, 2018. ISBN 978-0-12-813807-6. OCLC 1023628139.  Manba xatosi: Invalid <ref> tag; name ":5" defined multiple times with different content
  26. ↑ Aminoff's neurology and general medicine, Sixth Michael J. Aminoff: , London, 2021. ISBN 978-0-12-819307-5. OCLC 1235762322.  
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